Katie Deming, MD
Radiation Oncologist, Oregon
High-quality healthcare. Less time out of work and fewer trips to the hospital. Less money spent on co-pays. All of these seemed like no-brainers to me. So when I looked at the Choosing Wisely recommendation from the American Society for Radiation Oncology (ASTRO), it seemed like the right thing to do – both from patient and quality metrics perspectives.
The Choosing Wisely recommendation we decided to implement states that women age 50 and above with invasive node-negative breast cancer, who are treated with lumpectomy, should consider 3 to 4 weeks of radiation treatment rather than the previously prescribed 5 to 6 weeks. This would mean less driving back and forth to the hospital and less time away from work and their families. It would mean each woman saving between $450 and $600 in co-pays. And it would mean positive health outcomes.
We chose to implement this initiative in our clinic because a study released in 2014 in JAMA by Bekelman et al showed that only about one-third of women who qualified for this shorter treatment course were receiving it in community practice. In thinking through how to improve appropriate use of short-course radiation for breast cancer for our patients, we created guidelines for our physicians and a review process to ensure proper use of short-course radiation.
As part of this quality improvement effort, we partnered with Consumer Reports to use their patient-facing Choosing Wisely materials. That way, when clinicians were talking with their patients about this change in treatment protocol, patients would know that an independent, well-trusted, third-party organization was saying the same thing. So we laminated and hung in exam rooms the Consumer Reports materials called Ask Your Doctor: Questions About Radiation for Cancer and Radiation Therapy for Breast and Gynecological Cancers. Doctors and patients started looking at them together.
This idea of shortening radiation treatment for breast cancer was new to many women. Most of them had heard that six weeks was the standard treatment, and they were expecting that.
We showed them data from Canada and the UK, demonstrating their use of the three-week treatment protocol. But showing them materials from Consumer Reports was really helpful. They then understood that this wasn’t just us at Kaiser Permanente suggesting a shorter treatment, but that it was considered high-quality care by Consumer Reports and the American Society for Radiation Oncology.
Having the educational materials was a win-win for all sides. They provided important, well-written, science-based information for the patients, and quality teaching materials and talking points for the doctors. Having these materials was a great experience for us – and one that I would definitely recommend to other clinicians.
Now more women know about this shorter treatment option. And within six months of making these changes, we were able to get 98 percent of appropriate patients treated with short-course radiation. Our doctors were able to do the right thing for our patients. And our patients were able to save money, get back to work and their lives more quickly – and receive high-value, high-quality healthcare.
Consumer Reports has no financial relationship with this healthcare provider and does not endorse products or services.